AFFIDAVITS AND INDEMNITY AS TO DEBTS, LIENS, AND POSSESSION
(USE SEPARATE FORM FOR EACH PARTY)
(TO BE FILLED IN PERSONALLY BY SELLER OR BORROWER
IN HIS/HER OWN HANDWRITING)
GF # ___________________________
SUBJECT PROPERTY: ___________________________________________________ ________________________________________________________________________
STATE OF __________ §
COUNTY OF ________ § BEFORE ME, the undersigned authority, on this day personally appeared:
________________________________________________________________________
Seller or Owner-Borrower*
________________________________________________________________________
Contractor (if new construction)
personally known to me to be the person whose name is subscribed hereto and upon his/her oath deposes and says that no proceedings in bankruptcy or receivership have been instituted by or against him/her and that the marital status of Affiant has not changed since the day of acquisition of said property and represents to the purchaser and/or Lender in this transaction that there are:
1. No unpaid debts for lighting and plumbing fixtures, water heaters, floor furnaces, heaters, air conditioners, built-in fireplace screens, installed outdoor cooling equipment, swimming pool equipment, built-in cleaning equipment, built-in kitchen equipment, satellite dish, radio or television antennae, garage door openers, carpeting, rugs, lawn sprinkling systems, venetian blinds, curtains and rods, window shades, draperies and rods, valances, screens, shutters, awnings, mirrors, ceiling fans, attic fans, mail boxes, security and fire alarm detection equipment, water softener, electric appliances, fences, street paving, or any personal property or fixtures that are located on the subject property described above, and that no such items have been purchased on time payment contracts, and there are no security interests on such property secured by financing statement, security agreement or otherwise except the following:
Creditor
________________________________
________________________________
________________________________
(If NONE, write "NONE" on blank line)
Approximate Amount
________________________________
________________________________
________________________________
2. No loans, unpaid judgments, or liens (including Federal or State Liens or Judgment Liens) and no unpaid association or governmental taxes, charges or assessments of any kind on such property except the following:
Creditor
________________________________
________________________________
________________________________
(If NONE, write "NONE" on blank line)
Approximate Amount
________________________________
________________________________
________________________________
3. All labor and materials used in the construction of improvements on the above-described property have been paid for and there are now no unpaid labor or material claims against the improvements or the property upon which same are situated, and I hereby declare that all sums of money due for the construction of improvements have been fully paid and satisfied, except the following: ____________________________
________________________________________________________________________
(If NONE, write "NONE" on blank line)
4. No leases, contracts to sell the land, or parties in possession other than Affiant except as follows: ____________________________________________________ (If NONE, write "NONE" on blank line)
*5. To be filled in if a sale - "The Seller is not a non-resident alien, foreign corporation, foreign trust, foreign estate or other foreign entity (as defined in the Internal Revenue Code and Income Tax Regulations). Seller's U.S. employer identification number (or Social Security Number) is: _________________________. Seller's address (office address, if Seller is an entity; home address if Seller is an individual) is: _________________________________________________________
________________________________________________________________________
This Affidavit may be disclosed to the Internal Revenue Service and is furnished to Buyer to inform Buyer that withholding of tax is not required under Section 1445 of the Internal Revenue Code.
INDEMNITY: I AGREE TO PAY ON DEMAND TO THE PURCHASERS AND/OR LENDER AND/OR TITLE COMPANIES (INCLUDING STEWART TITLE GUARANTY COMPANY) IN THIS TRANSACTION, THEIR SUCCESSORS AND ASSIGNS, ALL AMOUNTS SECURED BY ANY AND ALL LIENS, CLAIMS, OR RIGHTS NOT SHOWN ABOVE, TOGETHER WITH ALL COSTS, LOSS AND ATTORNEY'S FEES THAT SAID PARTIES MAY INCUR IN CONNECTION WITH SUCH UNMENTIONED LIENS, PROVIDED SAID LIENS, CLAIMS, OR RIGHTS EITHER CURRENTLY APPLY TO SUCH PROPERTY, OR A PART THEREOF, OR ARE SUBSEQUENTLY ESTABLISHED AGAINST SAID PROPERTY AND ARE CREATED BY ME, KNOWN BY ME, OR HAVE AN INCEPTION OR ATTACHMENT DATE PRIOR TO THE CLOSING OF THIS TRANSACTION AND RECORDING OF THE DEED AND MORTGAGE.
I realize that the Purchaser and Lender and title companies in this transaction are relying on the representations contained herein in purchasing same or lending money thereon and issuing title policies and would not purchase same or lend money or issue a title policy thereon unless said representations were made. If Seller or Borrower is an entity, I have authority to sign on its behalf.
___________________________
___________________________
Sworn to and subscribed before me this _____ day of __________________, _______.
___________________________
Notary Public in and for ________________________
____________________________________________
* NOTE: This form is to be filled in and signed by Seller in case of sale. If no sale, it is to be filled in and signed by the Owner-Borrower. If there is any new construction, the contractor must also join in this form or fill in and sign a separate one.
** If Seller is a non-resident alien, foreign corporation, etc., call your manager or underwriting personnel (1-800-729-1902).
NOTE TO BUYER: Buyer must retain until end of fifth taxable year following taxable year of transfer and must file with the Internal Revenue Service if required by regulation or otherwise.
No guidelines are available for this form at this time.